Individual provider · Type 1 NPI

Etern S. Park, DDS, MD

Oral and Maxillofacial Surgery (Dentist) · Fargo, ND

NPI number 1124289905 Active

Practice location

1717 University Dr S
Fargo, ND 58103-4939

Call (701) 234-2000 Map

Mailing address

PO Box 5074
Sioux Falls, SD 57117-5074

Specialties and licenses

TaxonomyCodeLicense
Oral and Maxillofacial Surgery (Dentist) 1223S0112X2503 (ND)
Oral and Maxillofacial Surgery (Dentist) 1223S0112XC1-0011804 (DE)
Oral and Maxillofacial Surgery (Dentist) 1223S0112XG3-0000458 (DE)
Oral & Maxillofacial Surgery (D.M.D.) 204E00000X21037 (ND)
Oral & Maxillofacial Surgery (D.M.D.) 204E00000X269333 (NY)
Oral and Maxillofacial Surgery (Dentist) Primary 1223S0112X053210 (NY)

Oral and Maxillofacial Surgery (Dentist): The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.

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About NPI 1124289905

Etern S. Park, DDS, MD's National Provider Identifier is 1124289905, issued on Jun 24, 2008. The primary taxonomy on file is Oral and Maxillofacial Surgery (Dentist) (1223S0112X), and the practice location is in Fargo, ND. The record was last updated on Feb 11, 2025.